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Selected Publication:
Beqo, B.
Subcutaneous granuloma annulare versus subcutaneous vascular anomalies:
Is there a way to simplify the diagnostic difficulties, increase the diagnostic accuracy, and therefore facilitate the appropriate management.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2023. pp. 53
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- Authors Med Uni Graz:
- Beqo Besiana
- Advisor:
- Haxhija Emir
- Singer Georg
- Spendel Stephan
- Altmetrics:
- Abstract:
- The first article provides an overview of GA and its subvariant SGA. Various clinical and histopathological characteristics of the disease are discussed. Apparently, different imaging methods are used to clarify these lesions, and ultimately, surgery is often required to confirm the SGA diagnosis. This is illustrated by a case study of a girl who presented with an SGA lesion after a fall, which was confirmed through a biopsy. The article highlights the importance of clinical suspicion of SGA in locations typical for this disease, which can spare patients unnecessary surgical interventions to confirm the diagnosis. The second article aimed to identify an imaging sign that could aid in the accurate diagnosis of SGA without the need for invasive diagnostic procedures. This study retrospectively analyzed the charts and complete imaging of 28 children diagnosed with SGA at the Department of Pediatric and Adolescent Surgery of the Medical University of Graz. It was found that all SGA lesions had a pure epifascial extension with a well-defined broad-based rounded fascial border and an ill-defined crescent, cap-shaped epifascial border. We named this typical shape of the SGA lesion the "epifascial cap sign". We concluded that this imaging sign in combination with a detailed patient history, physical examination, and laboratory findings can lead to an accurate diagnosis of SGA without the need for a biopsy. The third publication aimed to investigate the diagnostic challenges between SGA and SVMs in children. Differentiating between SGA and SVM lesions is crucial for appropriate treatment and disease management. This study included a retrospective analysis of 12 children with SGA and 47 with low-flow SVMs who all underwent an MRI imaging. The results of the study showed that SGA and SVMs may have similar clinical appearances, but they differ substantially in imaging characteristic. We found that the presence of a homogenous epifascial cap, was a typical imaging sign for SGA, while SVMs present as irregular lesions with tubular or cystic appearance. These imaging differences should further aid in distinguishing between these two types of lesions. The fourth article is a letter to the editor concerning the article “Subcutaneous Granuloma Annulare in an Atypical Age Group in Immediate Post-Covid-19 Phase” by Kaur et al. We have suggested that the case presented in the article is more compatible with the diagnosis of generalized granuloma annulare (GGA) rather than SGA. The article explains that the clinical and histopathological images presented in the original article do not reveal typical SGA lesions but rather indicate GGA with a patchy pattern of small granulomatous islands. Our letter to the editor provides the reader with new insights about the novel SGA imaging sign that may help avoid unnecessary examinations and specialist consultations for children with SGA and enable accurate diagnosis through imaging alone. In conclusion, this doctoral thesis highlights the importance of accurate diagnosis of subcutaneous lesions in children and offers a non-invasive diagnostic tool to differentiate SGA from other subcutaneous lesions and especially from SVMs. The epifascial cap is a typical imaging sign of SGA lesions which, to the best of our knowledge, distinguishes this disease from other subcutaneous lesions. Recognition of this sign in an otherwise healthy child presenting with a symptomless subcutaneous lump over bony prominences should enable clinicians to diagnose SGA accurately, schedule the patient for a follow-up visit and prevent the majority of children with this disease from undergoing further invasive diagnostic procedures. A management algorithm for children with SGA has been developed.